Aetiology and clinical profile of patients presenting with erythroderma

Abstract Background: Erythroderma is a potentially fatal condition with haemodynamic and metabolic disturbances. The clinical course and prognosis of erythroderma vary depending on the underlying aetiology. There is a paucity of reliable published data from South India regarding aetiology and clinical profile of patients with erythroderma. Methods: We retrospectively studied the case records of 77 patients with a clinical diagnosis of erythroderma who presented to the dermatology, venereology and leprosy outpatient service at our tertiary care teaching hospital, during January 2017–May 2023. Results: Their mean age was 45.4 ± 18.5 years. There were 45 (58%) males. The most common presenting symptoms were erythema with scaling (100%), itching (83%), fever (52%), chills (31%), burning pain (31%) and weight loss (17%). The most common cause of erythroderma was drug induced in 31 (40%) patients, followed by psoriasis in 19 (25%), infectious dermatoses in 9 (12%) and eczema in 8 (10%) patients. Skin biopsy was performed in 60% of patients. Amongst the patients in whom skin biopsy was performed, histopathological diagnosis was in concordance with clinical diagnosis in 85% of patients. On multivariable analysis, drug-induced erythroderma (odds ratio [OR]: 8.4 ; P = 0.026) and duration of erythroderma less than a week (OR: 4.6 ; P = 0.05) were independently associated with resolution of erythroderma within 2 weeks of starting therapy. Conclusions: Meticulous history and clinical examination are sufficient to determine the aetiology of erythroderma in most cases, and biopsy may be required occasionally when the aetiology of erythroderma is not evident on history and clinical examination. Resolution of erythroderma is faster in acute presentations and drug-induced erythroderma.